Hatha yoga shows promise in the treatment of major depression

New preliminary research published in PLoS One indicates that yoga could help reduce symptoms of depression.

The study of 38 adults meeting the criteria for major depression found an 8-week hatha yoga program was linked to clinically significant reductions in symptom severity. Hatha yoga focuses on physical and mental strength building exercises and postures. Participants attended 90-minute hatha yoga practice groups twice weekly.

PsyPost interviewed the study’s corresponding author, Sudha Prathikanti of the University of California at San Francisco. Read her responses below:

PsyPost: Why were you interested in this topic?

Prathikanti: As a psychiatrist, I am very concerned that major depression is seriously under-treated in this country. Only half of Americans annually diagnosed with major depression seek out conventional care with pharmacotherapy or psychotherapy, and only one-fifth complete the level of care that is likely to treat their major depressive episode. Once initiated, both pharmacological and psychological therapies tend to have high dropout rates ranging from 20%-47%, influenced by social stigma, cost and duration of treatment, insufficient therapeutic alliance with the clinician, and potential medication side effects. Even among those completing a full course of treatment, remission rates are relatively low, ranging from 28% to 46%. With the rising popularity of yoga in western countries, yoga-based interventions with proven efficacy in major depression may provide a treatment option that is cost-effective, widely accessible, associated with high social acceptance, and has a favorable risk-benefit profile.

What should the average person take away from your study?

First, ours was a pilot study with results based on a small number of participants (38 total). So our results must be viewed with caution as early, exploratory data that support further, larger-scale studies of yoga in major depression, rather than as conclusive evidence of yoga’s mood effects.

That being said, findings from this pilot study raise the intriguing possibility of yoga as a mono-therapy (stand-alone treatment) for major depression of mild to moderate severity in a U.S. population. Previous to our study, the only other clinical trials that examined yoga as a monotherapy in major depression were conducted in India. While results from those trials were positive, it has been suggested that perhaps Indian participants were more likely to have culture-specific, positive expectations about the therapeutic value of yoga, so that findings may not apply well to western populations with major depression. Now, with our pilot study, the investigation of yoga as mono-therapy for major depression is supported for the first time in an urban U.S. community sample. If anti-depressant efficacy of hatha yoga are replicated in larger scale studies, this would be of enormous relevance to public health.

Are there any major caveats? What questions still need to be addressed?

In our clinical trial, we offered yoga as a mono-therapy in those diagnosed with major depression of mild to moderate severity, since studies show that these individuals may be the ones for whom conventional care with antidepressants or psychotherapy may offer the most uncertain benefit. However, in someone suffering from a more severe level of depression, especially with suicidal thoughts or difficulties in discerning reality, conventional care (including hospitalization) may be indicated and most effective; in such a context, it would be prudent to consider yoga as an add-on therapy, rather than as mono-therapy. Another major caveat is that this was a pilot study involving only 38 total participants; therefore, our results must be viewed with caution as encouraging preliminary data that warrant further investigation, rather than conclusive evidence of yoga’s mood effects. Future questions to address include:

• If yoga-specific mood benefits of this hatha yoga sequence are confirmed in future larger-scale studies, next steps might be to test whether increased practice intensity and/or increased adherence promote earlier manifestation of mood effects. One method to increase practice frequency (and perhaps enhance adherence) would be to augment on-site group practice with home practice, using instructional DVDs or online sessions.
• It also remains to be established whether acute mood effects of yoga suggested by short-term studies, such as this pilot trial, can be maintained in the longer term.
• Several populations may be particularly well served by increased research on yoga as a non-pharmacological therapeutic option for major depression. These populations include peri-partum women, adolescents, medically frail seniors, and those with medication sensitivities. While investigation of yoga has increased in peripartum women with depression, research has been minimal in the other populations mentioned above.

Is there anything else you would like to add?

Major depression is a complex disorder, with onset of illness influenced by multiple factors, including genetic vulnerability, nature of stressors, sources of support, and learned coping strategies. Therefore, it is highly unlikely that any single therapy will work uniformly well in all individuals with major depression. The goal in developing novel interventions, such as yoga, is not to replace existing conventional care that may be highly effective for some individuals, but to expand therapeutic options so that more people may benefit from treatment.

The study, “Treating major depression with yoga: A prospective, randomized, controlled pilot trial“, was also co-authored by Renee Rivera, Ashly Cochran, Jose Gabriel Tungol, Nima Fayazmanesh, and Eva Weinmann.